123例肝硬化患者眼底血管变化观察与分析

Observation and analysis of fundus vascular changes in 123 patients with liver cirrhosis

目的基于肝开窍于目的中医理论,观察肝硬化患者眼底血管变化,为肝硬化疾病的诊断及病情监测提供客观依据。方法运用专业数字眼底照相机采集肝硬化患者的眼底图像,对所有患者眼底血管改变进行量化分级,并运用计算机图像识别技术提取眼底图像特征,同时以性别、年龄相匹配的健康志愿者为对照,探讨不同肝功能分级肝硬化患者的眼底改变。结果共采集123例肝硬化患者眼底图像,其中,伴门脉高压者79例,肝功能Child-Turcotte-Pugh(CTP)分级A级44例,B级40例,C级8例,无法分级者31例。采集相匹配的健康志愿者眼底图像85例。与健康人相比,肝硬化患者眼底改变分级有统计学意义(U=2062.500,P=0.000),其中各项眼底改变的构成比比较,眼底动静脉比例失调(χ^(2)=22.712,P=0.000)、血管壁铜丝样改变(χ^(2)=20.089,P=0.000)、血管扭曲(χ^(2)=28.609,P=0.000)及视网膜渗出(χ^(2)=5.575,P=0.017),均有统计学意义;不同CTP分级肝硬化患者眼底血管改变,CTP B级的较A级明显(χ^(2)=9.133,P=0.026);伴与不伴门脉高压患者的眼底动静脉比例失调的构成比比较,有统计学意义(U=742.000,P=0.043);基于计算机图像识别技术提取的肝硬化患者眼底特征比较,伴门脉高压者眼底血管图像的bsd、var值低于不伴门脉高压者(U_(bsd)=508.000,P=0.018;U_(var)=511.000,P=0.019)。CTP A级患者眼底图像的asm值大于B级及C级(H=10.037,P=0.007),ent值小于B级及C级(H=9.669,P=0.008),CTP B级的bsd、con、var、sen、dva、den的值大于A级(H_(bsd)=7.398,P=0.025;H_(con)=7.493,P=0.024;H_(var)=6.721,P=0.035;H_(sen)=8.251,P=0.016;H_(dva)=7.493,P=0.024;H_(den)=7.761,P=0.021),idm值小于A级(H=6.805,P=0.033)。结论肝硬化患者的眼底血管发生明显改变,主要表现为眼底动静脉比例失调、血管壁铜丝样改变、血管扭曲及渗出;肝功能不同CTP分级、伴与不伴门脉高压的肝硬化患者间眼底血管改变特征存在差异,提示眼底血管改变可能和肝硬化疾病的进展相关。

OBJECTIVE To observe fundus vascular changes in patients with liver cirrhosis and provide objective basis for the diagnosis and monitoring of the disease based on the theory of Traditional Chinese Medicine(TCM).METHODS The fundus images of patients with liver cirrhosis were captured with professional digital fundus camera.The alterations of fundus vasculature in all subjects were quantified and graded.Features of the fundus images were extracted by computer image recognition technology.At the same time,the gender and age matched healthy volunteers were used as controls to explore the fundus changes of liver cirrhosis patients with different liver function grades.RESULTS Fundus images of 123 patients with liver cirrhosis were collected,including 79 patients with portal hypertension,44 patients with Child-Turcotte-Pugh(CTP)Grade A,40 patients with CTP Grade B,eight patients with CTP Grade C,and another 31 patients who could not be graded.A total of 85 fundus images were collected from gender and age matched healthy volunteers.Compared with the normal control,the grading of fundus vascular changes in patients with liver cirrhosis was statistically significant(U=2062.500,P=0.000),Statistically significant changes were also found in the disproportion of fundus arterio-venous ratio(χ^(2)=22.712,P=0.000),as well as the presence of copper-like changes in vessel wall(χ^(2)=20.089,P=0.000),vascular distortion(χ^(2)=28.609,P=0.000)and retinal exudation(χ^(2)=5.575,P=0.017).Fundus vascular changes were more significant in CTP Grade B patients than in CTP Grade A patients(χ^(2)=9.133,P=0.026).There were statistically significant differences in the constitutional ratio of fundus arterio-venous dispropotion between patients with or without portal hypertension(U=742.000,P=0.043).The results of fundus features extracted from patients with liver cirrhosis based on computer image recognition technology demonstrated that bsd and var value were lower in patients with portal hypertension than those without(U_(bsd)=508.000,P=0.018;U_(var)=511.000,P=0.019).The asm value of fundus images of CTP Grade A patients was higher than that in CTP Grade B and C patients(H=10.037,P=0.007),while the ent value was lower(H=9.669,P=0.008).The values of bsd,con,var,sen,dva and den in CTP Grade B patients were higher than those in CTP Grade A patients(H_(bsd)=7.398,P=0.025;H_(con)=7.493,P=0.024;H_(var)=6.721,P=0.035;H_(sen)=8.251,P=0.016;H_(dva)=7.493,P=0.024;Hden=7.761,P=0.021),while the idm value was lower(H=6.805,P=0.033).There were all statistically significant differences.CONCLUSIONS There were obvious fundus vascular changes in patients with liver cirrhosis,mainly manifested as the imbalance of fundus arterio-venous ratio,copper-like vascular wall changes,vascular distortion and exudation.The characteristics of fundus vascular changes were different among liver cirrhosis patients with different CTP grades of liver function and with or without portal hypertension,indicating that fundus vascular changes might be related to the progression of liver cirrhosis.